The Conservative Party manifesto 2015 pledged to ‘protect and improve’ the NHS. So what is this likely to mean for the NHS over the next five years? In this article, Jamie Foster of Hempsons, considers the implications of the Conservative Party’s election victory
The headline news – and the subject of David Cameron’s first major post-election speech – is the commitment to transform the NHS into a seven-days-a-week service.
Equally significant is the commitment to implement the NHS Five Year Forward View (FYFV), the long-term plan for how the NHS needs to change to meet the challenges it faces. The FYFV and the Conservative Party manifesto identify a number of ways in which the NHS can seek to meet these challenges. These include:
- A radical upgrade in prevention and public health, building on the statutory responsibility of local authorities to improve the health of their populations. For example, Diabetes UK estimated that the NHS already spends about £10 billion each year on diabetes care and the Government wants to be the first country to implement a national, evidence-based diabetes prevention programme
- Empowering patients to take greater control of their care through increased access to information, including transparent information about hospital and other service providers, and the development of electronic health records
- Increased personalisation through extended rights to personal budgets. People with continuing healthcare needs already have the right to a personal health budget and the intention is to extend this right, including by introducing ‘integrated personal commissioning’ that integrates health and social care budgets for individuals
- Strengthened partnerships between the NHS and charities and voluntary organisations to recognise the importance of the sector’s role in delivering services
- Supporting a modern workforce with the right skills, values and behaviours to meet the challenges faced by the NHS
- Exploiting the information revolution and accelerating health innovation, including, for example, through the genome project, the roll out of medical devices and a new approach to the Cancer Drugs Fund
- Integrating health and social care systems to build on the Better Care Fund (BCF) programme (of which more below), including to tackle dementia
- Ensuring that mental health is taken as seriously as physical health by increasing funding for mental health care
- A commitment to increase NHS spending in real terms by a minimum of £8 billion over the next five years
In addition, the FYFV set out plans to redesign health and care systems to improve quality of care, reduce health inequalities, and address productivity and efficiency challenges. To make this happen it proposes stimulating the creation of a number of major new care models.
NHS England’s commissioning intentions indicate a continuing desire to develop consolidated centres of excellence for specialised services where quality and patient volumes are strongly related, but not at the expense of the local acute hospital model
The FYFV suggests that while the answer is not one-size-fits-all, nor is it simply to let ‘a thousand flowers bloom’. It proposes that the NHS should test a number of models and in response to this NHS England has set up a programme to accelerate the design and implementation of new care models. Twenty-nine ‘vanguard’ geographies have been chosen that will take the national lead on transforming care for patients in towns, cities and counties across England.
This complements work in other areas intent on transforming care, including in Greater Manchester. A memorandum of understanding has been signed by all Greater Manchester local authorities, CCGs and NHS England to develop a framework for the devolution of health and social care responsibilities. The Government is keen to extend this devolution model to other cities.
All of these developments aim to support improvement and integration of services by breaking down traditional divides between primary care, community services, secondary care and social care, and by delivering increasingly-personalised and integrated care for patients. The assumption is that if organisations work together then better outcomes may be achieved. New care models will involve all types of commissioners and providers of NHS-funded and local-government funded services.
So what are these new care models? Broadly, they can be summarised as follows:
- Integrating primary care with community and acute services – the FYFV suggests that some of the challenges facing the NHS can be met by strengthening and expanding primary care services through integration with secondary care services, in the form of the primary and acute care systems (PACS) model, and with community services, in the form of the multispecialty community provider (MCP) model.
- Model integrating health and social care – the BCF has sought to address some of the challenges facing the NHS by requiring CCGs and local authorities to commission services in an integrated way for 2015/16. There is likely to be pressure to build on the initial BCF schemes to reduce avoidable admissions to hospital and commission out-of-hospital care, for example by commissioning enhanced health in care homes, one of the models suggested by the FYFV
- Model integrating hospital services across multiple organisations and sites – NHS England’s commissioning intentions indicate a continuing desire to develop consolidated centres of excellence for specialised services where quality and patient volumes are strongly related, but not at the expense of the local acute hospital model. For both specialist trusts and other acute hospitals there will be opportunities to work collaboratively in networks to share clinical, back office and management expertise. It will be interesting to see how the ‘vanguard’ organisations take forward implementation of their new care models and how the rest of the NHS responds to this and to the challenges facing the NHS generally
There is consensus that the NHS needs to change to meet the significant challenges it faces – but there is opposition to making some of the changes which the Government believes are necessary
The Government wants to transform access to the NHS by ensuring everyone will be able to see a GP and receive high-quality hospital care seven days a week. This is, of course, admirable, but does give rise to a concern about how it will be funded. The funding gap identified by the FYFV assumes that services continue to be provided in their current form rather than being extended to seven days a week. So will new funding be made available for this, or will reconfiguration and consolidation of existing services be required to free up money for seven-day working?
There are also potentially-significant workforce implications associated with providing seven-day services. Existing inhibitors to the change in hospitals include consultants’ right to refuse non-emergency work (between 7pm-7am and weekends), restrictions on junior doctors’ working hours, and the enhanced payments for unsocial hours under the Agenda for Change. The negotiations between NHS Employers and the BMA are likely to start again soon after they broke down at the end of last year. This may lead to the removal of some of the inhibitors, but there will be other challenges associated with a likely increase in shared service provision. Where organisations collaborate to provide services, these will include TUPE transfers and secondments and a need to increase the skill mix across the NHS workforce.
There is consensus that the NHS needs to change to meet the significant challenges it faces – but there is opposition to making some of the changes which the Government believes are necessary. Both the FYFV and the Government’s plans to implement it are ambitious, making it likely that the next five years will be both interesting and challenging.